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Childhood obesity is an increasing problem in the UK with roughly one in seven school aged children in Scotland and England being classified as obese. The picture is similar in Wales where the prevalence is one in eight. The direct cost of obesity to the NHS is estimated to be £4.2bn a year, with this set to rise if the causes of childhood obesity are not addressed. The contribution of the research described below to tackling this issue is manifold: it has enabled the development and improvement of child health interventions/programmes; it has allowed commissioners and programme leads to make more informed decisions about investment in these interventions/programmes; and it has contributed to the development of regional healthy weight strategies and national guidelines on weight management.
With childhood obesity now of global public health and clinical importance, attention had to be directed toward how best to identify the condition and more importantly those who are at further risk of serious obesity-related conditions. This case study illustrates how assessment has moved beyond the simple crude measure, challenging the accepted approach and developed more sensitive and specific assessment tools. Described is a new range of clinical assessment charts which allow practitioners and epidemiologists to evaluate a range of body characteristics known to be linked to morbidity, make a fuller assessment of individual risk and target better and specific intervention.
Obesity is a global epidemic. Currently, more than half a billion adults worldwide are estimated to be overweight or obese yet this problem is entirely preventable. Excess weight costs the NHS over £5 billion each year and is associated with an increased risk of obesity-related disease (e.g. type 2 diabetes and heart disease). University of Glasgow researchers defined two `Action Levels' for waist circumference to indicate the point when an individual needs to initiate weight loss to reduce their risk of disease. These Action Levels have been incorporated into national and international clinical guidelines for the diagnoses and management of obesity-related disease, and have provided the foundation for public-health campaigns and policies worldwide, designed to reduce the burdens of chronic ill-health that follow obesity.
Our sustained impact in obesity treatment began in 1999 with Europe's first residential camp programme for overweight and obese children. Our impact on treatment grew sufficiently to warrant the formation of a dedicated spin out company, MoreLife. Underpinned by our research, MoreLife is an award winning, Department of Health accredited provider, delivering specialist weight management services, both nationally and internationally. Through NHS and other contracts we are delivering high quality, evidence based services to over 3,500 adults and 3000 young people per year. Our impact on the policy and practice of obesity treatment and public understanding continues in the UK and has been extended internationally.
Research at the UCL Institute of Child Health underpinned the update in 2009 of children's growth charts, which allow for more accurate determination of a child's growth pattern and provide better tools for assessing possible weight problems in children. The new charts are now in universal use in the UK for children from birth to 18 years of age, including preterm babies. Having been quickly adopted, they now account for 90% of all growth chart sales. Modified versions of the charts are in use in Ireland and New Zealand. In the UK they are provided to all new parents as part of the Personal Child Health Record (PCHR) — known as the "red book". They are used in general practice, community paediatrics, general paediatrics and paediatric endocrinology. The most recent charts are for use in children with growth or nutritional problems.
Research in the area of childhood obesity has focussed on the development, implementation and evaluation of interventions. The APPLES Study (1996-99), the first UK school-based RCT was key in contributing to the evidence-base through wide dissemination including 3 BMJ (2001) publications, cited in NICE (2006) and WHO guidance (2004). Collaborations with academics, practitioners and the RCPCH led to the development of further community-based obesity treatment and prevention interventions including WATCH IT; early programmes e.g. EMPOWER, HELP and HAPPY and more recently innovative school-based initiatives involving school gardening. There is evidence of results being disseminated and influencing research, practice and policy.
This case study represents the work of the Pyramid research team within the INSTIL Education Research Group (INSTIL ERG). Research at the University of West London is characterised by an ambition to promote `useful knowledge' and this case study, with its focus on providing evidence to inform and direct practice, fits within this approach. The case study describes the first rigorous evaluation of the impact of Pyramid after-school clubs that aim to improve the socio-emotional wellbeing of vulnerable children. The work of the Pyramid research team provides an empirical evidence base to support the work of a range of stakeholders including: practitioners; policy makers and researchers in the field of children's socio-emotional well-being, and the children and their families. Drawing on the evidence base, these impacts include the securing of funding for the continuation of Pyramid clubs in schools and informing future development and extension of the Pyramid club intervention for delivery to other age groups.
Every child born in the UK receives a set of growth charts with their Personal Child Health Record. These charts have been developed and designed by Professor Charlotte Wright, University of Glasgow. Growth monitoring is fundamental for the assessment of health and the identification of growth abnormalities in children, and growth charts are used to interpret these measurements. The design of child growth charts and the instructions for their use influences perceptions of normality and drives screening activity for conditions such as failure to thrive or obesity. The newly developed UK child growth charts more accurately reflect healthy growth patterns than previous versions, and feature a range of design improvements and evidence-based, straightforward instructions for use. They have been endorsed by the key professional societies for child health and nutrition in the UK, and are being used by health professionals and parents throughout the UK, Ireland and New Zealand.
Obesity in the UK is a growing problem for individuals and for NHS resources.a,f There is evidence to suggest that the Government's healthy living messages are failing to get through, as figures show obesity levels have almost doubled in 14 years.a,f More than half the adult population are now overweight or obese.b The report led by Waumsley that reviews the evidence base for psychological approaches to obesity and provides guidelines for practitioners forms the basis for this impact case. This influential research on secondary data was commissioned by the British Psychological Society (BPS) and remains their position statement on obesity, and features in advice to the general public on obesity in adults. As lead, Waumsley participated in a House of Lords cross-party seminar on behaviour change and obesity, has been an expert discussant on obesity at the BPS Annual Conference, and will lead the BPS's response to the National Institute for Health and Care Excellence (NICE) consultation on Overweight and obese adults: lifestyle weight management.
UK and international comparative research on socioeconomic inequality in early childhood, conducted by University of Bristol in conjunction with international colleagues, has profoundly influenced a variety of UK policy initiatives since 2010. Reliable evidence on the extent of learning deficits among recent cohorts of socio-economically disadvantaged children in early childhood has led to widespread acceptance in government that policy to promote equality of opportunity must begin in the preschool period. Analysis of the factors underpinning the disparities has led to and informed the development of official UK indicators to monitor progress in this area and specific policies to support parents, with outstanding potential to impact positively on the life chances of disadvantaged children. These include, for example, free childcare places for disadvantaged two-year-olds, an increased number of health visitors and the launch of telephone and online services for parents.